Romdhani Ahmed, Lehmann Stephanie, Schlatter Joël
Département Medico-Universitaire de Gériatrie, Hôpital Paul Doumer, Assistance Publique des Hôpitaux de Paris (AP-HP), Labruyère, France.
Pôle d'hospitalisation et relation ville-hôpital, Centre Hospitalier de Saint Marcellin, Isére, France.
Ther Clin Risk Manag. 2023 Mar 28;19:291-299. doi: 10.2147/TCRM.S395449. eCollection 2023.
Polypharmacy increases the risk of unbearable side effects, drug-drug interactions, and hospitalizations in geriatric patients. The iatrogenic risk of inadequate management of antidepressants is very important in this population. Therefore, primary care physicians and geriatricians have the responsibility of the optimization of antidepressants prescriptions. Our work is a literature review of the European and the international guidelines regarding the management of antidepressants. We reviewed the PubMed database and Google scholar for articles and reviews from 2015. We also screened relevant articles for more references and searched the web for available European guidelines relevant to our topic. We divided our findings into four main inquiries that are Indication, effectiveness, tolerability, and iatrogenic risks. Poor or absence of effectiveness should lead to a readjustment of the treatment plan. In case of unbearable side effects, antidepressants should be stopped, and alternative non-pharmacological therapies should be proposed. Doctors should look out for drug-drug interaction risks in this population and constantly adjust the prescription. Prescription of antidepressants is not always evidence based which leads to heavy iatrogenic consequences. We suggest a simple 4-questions-algorithm that aims to remind doctors of the basics of good practice and helps in the process of deprescribing an antidepressant in older adults.
多重用药会增加老年患者出现难以忍受的副作用、药物相互作用及住院治疗的风险。在这一人群中，抗抑郁药管理不当所带来的医源性风险非常高。因此，初级保健医生和老年病医生有责任优化抗抑郁药的处方。我们的工作是对欧洲和国际上有关抗抑郁药管理的指南进行文献综述。我们检索了PubMed数据库和谷歌学术，查找2015年以来的文章和综述。我们还筛选了相关文章以获取更多参考文献，并在网上搜索与我们主题相关的欧洲现有指南。我们将研究结果分为四个主要问题，即适应证、有效性、耐受性和医源性风险。疗效不佳或无效应导致调整治疗方案。如果出现难以忍受的副作用，应停用抗抑郁药，并建议采用替代性非药物疗法。医生应留意这一人群中药物相互作用的风险，并不断调整处方。抗抑郁药的处方并非总是基于证据，这会导致严重的医源性后果。我们提出了一个简单的四问题算法，旨在提醒医生注意良好做法的基本要点，并有助于老年患者停用抗抑郁药的过程。
